Provider Demographics
NPI:1427545060
Name:REYNOLDS, STACY LIZBETH (LPN)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:LIZBETH
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2798 HAZELTON CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1629
Mailing Address - Country:US
Mailing Address - Phone:513-375-7314
Mailing Address - Fax:
Practice Address - Street 1:2798 HAZELTON CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1629
Practice Address - Country:US
Practice Address - Phone:513-375-7314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN156322164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse